Experts Explain Changes to Prescription-Tracking System

The Kentucky All-Schedule Prescription Electronic Reporting system, the key to fighting doctor-shopping for painkillers in the state, has undergone several changes since the legislature passed House Bill 1 last year to crack down on so-called pill mills. An expert panel at "The Different Faces of Substance Abuse"conference last week in Lexington addressed the more recent changes to KASPER.

“The new legislation has brought prescription drug use into the medical arena when it had not been before,” said Dr. Michelle Lofwall, member of the KASPER Advisory Council, created last year by Gov. Steve Beshear.

Very soon Kentucky will be sharing KASPER data with all seven border states, which will be provided automatically in reports, and all agreements to enable this exchange have already been signed, said Van Ingram, executive director of the Kentucky Office of Drug Control Policy.

One important but little-reported change is that KASPER reports can now be included in patients’ medical records. Prior to the passage of HB1, this was a felony and created workflow problems for physicians.

Attorney General Jack Conway has steered money from a mortgage settlement to enable the necessary system upgrades to KASPER that will bring about additional changes, said Ingram. Starting in July, dispensers of drugs will be required to report data every 24 hours instead of the current weekly timeframe, improving the timeliness of the data.

Changes are also coming to the regulations associated with HB1, since medical licensure boards have “gotten an earful” and have revisited the regulations to make them more straightforward and common sense, KASPER program manager Dave Hopkins said.

Ingram said, “With any big policy change, there are going to be unintended consequences. . . . The legislature will take a look at the unintended consequences. If you want to make drastic changes, it’s going to be chaos for a while.”

“In a lot of things with government, great ideas are complicated by reality,” said Dr. Ryan Stanton, UK Good Samaritan Hospital emergency-room physician and medical director, as he painted a more realistic picture of KASPER from when he first created an account with the system in 2005.

Stanton said recent changes have included timelier and more accurate reports that make the system easier to use. He said more such improvements are critical to catch those who "abuse in spurts," and are also important because physicians have minimal time and need to spend more time with patients instead of in front of a computer.

The use of KASPER has increased significantly since the passage of HB 1, with the number of reports requested increasing from 811,000 in 2011 to 2.69 million in 2012.

Medications containing the painkiller hydrocodone, including Lortab, Lorcet and Vicodin, remain the most-prescribed type of controlled substance in Kentucky, 41.5 percent of the total.